MOH decides not to isolate zika patients anymore

—Cessation of isolation, MOH to subsidise Zika testing for all Singaporeans with symptoms

From 6 September 2016, the Ministry of Health (MOH) will no longer require suspect Zika cases to be isolated while waiting for test results. As the cases of Zika in Singapore have been mild so far, confirmed cases will no longer need to be hospitalised unless medically indicated. From 7 September, MOH will extend subsidies for the Zika test to all Singaporeans with Zika symptoms.

As of noon on 5 September 2016, there are three clusters and 16 cases with no known links to other cases and clusters. Over time, we expect Zika cases to emerge in more areas given the presence of the Aedes mosquitoes here. MOH and the National Environment Agency (NEA) will therefore adjust our strategies to manage Zika in the same way that we deal with dengue.

Isolation of suspect and confirmed Zika cases to cease

Currently all suspect cases of Zika infection are isolated in hospitals as an added precaution while awaiting confirmation of their blood test results. As more cases emerge, there is evidence that there is transmission in the community with the presence of infected mosquitoes. Furthermore, most of the patients do not display symptoms. Therefore isolation of patients with symptoms will have limited effect.

We have observed that Zika cases seen here have had mild symptoms, similar to the experience in other countries. Hospitalisation of all infected patients is therefore unnecessary.

From 6 September 2016, patients can return home to wait for their test results after their urine and/or blood samples have been taken at the clinics or hospitals. They will be given advice on protecting themselves from mosquito bites. Patients who test positive for Zika will be hospitalised only if judged clinically necessary by their doctor. This is similar to how dengue patients are managed.

Subsidised Zika testing for all Singaporeans with symptoms

Zika is generally a mild disease, and patients typically recover within 4 to 7 days. However, Zika virus infection can have more serious implications for a pregnant woman, as the virus can sometimes cause microcephaly in a small number of unborn foetuses. Should a pregnant woman be tested positive for Zika, her doctor will follow up closely with her to monitor her health and the development of her baby.

Zika testing criteria for Singaporeans who are not pregnant

For those who are not pregnant, confirming a Zika infection generally does not have an impact on the clinical management, which is currently focused on relieving symptoms. It is however useful in directing vector control efforts. Thus far, our considerations for testing for Zika are based on the assumption that most cases are still clustered in the affected areas*. Thus, those with symptoms and who live, work or study in the affected areas can get the test free, while others have to pay for the full cost of the test.

However, as more cases are found in other parts of Singapore, testing will no longer be focused on the clusters only, and we will provide a subsidy for the test by the public sector laboratories as follows:

For subsidised patients at the public healthcare institutions, they will pay a subsidised rate of $60 if they have Zika symptoms regardless of where they live, work or study. Patients who need the test but cannot afford it can approach the medical social worker for assistance, such as from Medifund.

For private patients in the public healthcare institutions, and patients at private clinics and private hospitals, they will pay the full cost of $150 for the Zika test.

Doctors will continue to make the clinical judgment on individuals whether testing of Zika is necessary.

Zika testing criteria for Singaporean Pregnant Women

Pregnant women will remain a special group to whom we will make Zika tests more affordable and accessible. Doctors will continue to make the clinical judgment whether testing of Zika is necessary, and for those who have Zika symptoms or whose male partner is Zika-positive, the public sector laboratories will continue to extend free Zika tests to patients at the public healthcare institutions, as well as those at private hospitals and clinics.

The Clinical Advisory Group on Zika and Pregnancy has advised that testing is not routinely recommended for pregnant women who do not have symptoms of Zika and whose male partners are not Zika-positive. However, should they still wish to be tested for Zika and have been assessed by their doctor to require testing, they can access the subsidised tests at $60 if they are subsidised patients at our public healthcare institutions.

The summary of the public sector laboratory charges for Zika tests can be found in Annex A. The subsidies for Zika tests for the various eligible groups will be borne by MOH. Patients will have to pay the other usual charges such as doctor’s consultation fee, on top of the Zika test.